Impact of gender differences on myocardial salvage and post-ischaemic left ventricular remodelling after primary coronary angioplasty: new insights from cardiovascular magnetic resonance
Impact of gender differences on myocardial salvage and post-ischaemic left ventricular remodelling after primary coronary angioplasty: new insights from cardiovascular magnetic resonance
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DOI：
10.1093/ehjci/jes087
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发表时间：
2012-11-01
影响因子：
6.2
通讯作者：
Agati, Luciano
中科院分区：
文献类型：
--
作者：
Canali, Emanuele;Masci, Pier;Agati, Luciano
性别对直接冠状动脉成形术（PPCI）后再灌注和左心室（LV）重塑（LVR）的影响存在相互矛盾的证据。在一组再灌注ST段抬高型心肌梗死（STEMI）患者中，采用综合心脏磁共振（CMR）方法评估了心肌再灌注的性别相关差异和LVR的性别相关差异。（238名男性和45名女性）连续STEMI患者，在症状发作后12小时内接受PPCI治疗，在STEMI后3 - 2天和4个月随访时接受CMR。通过CMR评估危险面积、梗死面积（IS）、微血管阻塞（MVO）和心肌挽救指数（MSI）。女性年龄大于男性（P 0.014），高血压（P 0.001）和梗死前心绞痛更常见（P 0.018）。在两个时间点，女性的MSI程度显著更高（P 0.013），IS显著更小（急性P 0.001，随访P 0.001），MVO程度显著更小（P 0.001）。在多变量分析中，Killip等级和女性性别与较高的MSI独立相关（分别为P 0.02、P 0.05）。随访时观察到两种性别的LVR发生率相似（P 0.808）。在我们的再灌注STEMI人群中，通过CMR观察到女性的再灌注模式更好，表明存在性别差异。在随访时未观察到LV重构发生率的性别差异，主要发生在IS较大的患者亚组中。
There is conflicting evidence on the impact of gender on reperfusion after primary coronary angioplasty (PPCI), and on left ventricular (LV) remodelling (LVR). In a cohort of patients with reperfused ST elevation myocardial infarction (STEMI), gender-related differences on myocardial reperfusion, and sex-related differences on LVR were assessed by using a comprehensive cardiac magnetic resonance (CMR) approach.In four tertiary referral centres, 283 (238 males and 45 females) consecutive STEMI patients, treated with PPCI within 12 h from symptoms onset underwent CMR 3 2 days after STEMI and at 4-month follow-up. By CMR, the area at risk, infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI) were assessed. Women were older than men (P 0.014), more hypertensive (P 0.001) and more frequently presented with pre-infarct angina (P 0.018). An MSI extent was significantly higher (P 0.013), IS was significantly smaller at both time points (acute P 0.001, follow-up P 0.001), and the MVO extent was significantly smaller (P 0.001) in women. At multivariate analysis, Killip class and female sex were independently associated with a higher MSI (P 0.02, P 0.05, respectively). A similar incidence of LVR in both sexes was observed at follow-up (P 0.808).The better reperfusion pattern observed in women by CMR in our population of reperfused STEMI suggests sex-based differences exist. No gender differences were observed with respect to incidence of LV remodelling at the follow-up mainly occurring in the subset of patients with a larger IS.